Healthcare Provider Details

I. General information

NPI: 1316694326
Provider Name (Legal Business Name): IVY NGOCYEN NGUYEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 06/23/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W BASTANCHURY RD # 1D
FULLERTON CA
92835-2522
US

IV. Provider business mailing address

111 W BASTANCHURY RD # 1D
FULLERTON CA
92835-2522
US

V. Phone/Fax

Practice location:
  • Phone: 714-732-9888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number35046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: